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Neonatal sepsis with possible HSV — RCPSC EM MCQ

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HardPaediatric emergenciesNeonatal sepsis with possible HSVRCPSC EM

A 12-day-old has poor feeding, lethargy, hypothermia, capillary refill of 4 seconds and vesicles on the scalp. What is the immediate management plan?

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Correct answer: E — Start IV acyclovir and full neonatal sepsis treatment

The best answer is “Start IV acyclovir and full neonatal sepsis treatment”. Neonatal HSV can present as sepsis-like illness and progress rapidly, with or without extensive lesions. This infant needs resuscitation, a full septic and HSV evaluation and immediate IV acyclovir alongside empiric neonatal antibacterial therapy; diagnostic testing must not delay treatment. Topical or oral antiviral treatment is inadequate.

Reference: Canadian Paediatric Society: Prevention and management of neonatal herpes simplex virus infection: https://cps.ca/en/documents/position/prevention-management-neonatal-herpes-simplex-virus-infections